2025-05-08T15:59:49-05:00 2024-06-30 390758449 WIPFLI LLP 105 E PINE ST UPPER FLOOR MISSOULA MT 59802 990 2023-07-01 810469886 POWELL COUNTY MEMORIAL HOSPITAL ASSOC POWE 4068462212 1100 HOLLENBACK LANE DEER LODGE MT 59722 JAENA RICHARDS CEO 4068462212 2025-04-22 1 1 SAM BRUNSON CPA P01696998 4067281800 2025-04-22 2023 2025-03-06 01:10:19Z DEER LODGE MEDICAL CENTER JAENA RICHARDS 1100 HOLLENBACK LANE DEER LODGE MT 59722 26751100 0 X DLMED.ORG X 1991 MT TO PROVIDE PATIENT FOCUSED HEALTHCARE. 7 7 175 7 0 0 346550 66207 23509843 25762684 155376 372730 387878 542353 24399647 26743974 0 0 0 0 12789409 13430435 0 0 0 10580149 11610389 23369558 25040824 1030089 1703150 41385725 42409090 19475401 18403858 21910324 24005232 TO PROVIDE PATIENT FOCUSED HEALTHCARE. 0 0 21641146 0 26255066 THE HOSPITAL PROVIDES DAILY PATIENT CARE SERVICES AND IS THE ONLY SOURCE OF THESE SERVICES IN THE AREA. THE HOSPITAL NOW ALSO HAS AN AMBULANCE SERVICE. 21641146 1 1 0 0 0 0 0 0 0 0 1 0 0 1 0 0 0 1 0 0 0 0 0 0 0 0 1 1 0 0 1 1 0 0 0 0 0 0 0 1 0 1 0 0 0 0 1 1 0 0 0 1 46 0 175 1 0 0 0 0 0 0 0 0 0 0 0 0 X 7 7 0 1 0 0 0 0 0 1 1 0 0 1 1 1 1 1 1 1 1 0 X JENNIFER SPRING 4068462212 1100 HOLLENBACK LANE DEER LODGE MT 59722 JACK ANDERSON PRESIDENT 1.00 X X 0 0 0 TERRY MOSIER VICE PRESIDENT 1.00 X X 0 0 0 JIM DECKER SECRETARY/TREASURER 1.00 X X 0 0 0 HOWARD NECKELS DIRECTOR 1.00 X 0 0 0 CARLEE HANSEN DIRECTOR 1.00 X 0 0 0 COLTER CUMIN DIRECTOR 1.00 X 0 0 0 ED MCCARTHY DIRECTOR 1.00 X 0 0 0 JENNIFER SPRING CFO 40.00 X 166771 0 8532 TONY PFAFF CEO 40.00 X 0 0 0 ANDREW BECK CNO 40.00 X 173795 0 33448 JAENA RICHARDS COO 40.00 X 211742 0 38393 JUDITH WILSON MD 24.00 X 243127 0 14166 LORI DRUMM DO 32.00 X 260074 0 43769 VAUGHN JOHNSON MD 40.00 X 394283 0 37239 PATRICK KRACH COO 32.00 X 231747 0 14361 SCOT MURRAY MD 32.00 X 488928 0 56239 SUMERA QAMAR MD 32.00 X 279629 0 13851 2450096 0 259998 19 0 1 0 SCOTT RIGDON CRNA MPHTRANSCENDENT A 330 TRIPLE TREE RD BOZEMAN MT 59715 ANESTHESIA AND PAIN MGMT. SERVICES 684586 CYPRESS HEALTHCARE LLC 791 EASTSIDE ROAD DEER LODGE MT 59722 MANAGEMENT, CEO AND TRAVEL 655973 CHAD COLVIN DBA HIGH MTN CRITIAL CA 926 W SHERASON DR EAGLE ID 836167156 EMERGENCY ROOM PHYSICIAN 391198 MAYO COLLABORATIVE SERVICES PO BOX 9146 MINNEAPOLIS MN 55480 REFERENCE LAB 297059 MONIDA SHARED IMAGING 1200 S RESERVE STE H MISSOULA MT 59801 MRI SERVICES 243702 7 1899 38957 25351 66207 NET PATIENT SERVICE REVENUE 621110 22979123 22979123 UTILIZATION FEE REVENUE 621110 2035128 2035128 OTHER OPERATING REVENUE 621110 748433 748433 25762684 273470 273470 53005 3034 49971 49971 49971 103352 4092 99260 99260 99260 340B REVENUE 621110 492382 492382 492382 26743974 26255066 0 422701 X 938842 827932 110910 9135892 8058456 1077436 289476 254739 34737 2323044 2044279 278765 743181 653999 89182 15691 15691 4027284 3259463 767821 95946 225 95721 290611 207860 82751 390017 69994 320023 218600 218600 105988 65717 40271 498597 478653 19944 1220640 1171814 48826 308277 295946 12331 SUPPLIES 2882533 2786055 96478 REPAIRS & MAINTENANCE 494269 395812 98457 LICENSES & TAXES 444018 377573 66445 BAD DEBT EXPENSE 226417 226417 391501 247612 143889 25040824 21641146 3399678 0 882702 1004251 6910218 7821267 3589799 3660408 38157 31517 595032 518231 236123 289123 31162342 10468576 21439440 20693766 5346421 6002802 35698 35698 2312135 2352027 41385725 42409090 2934066 2871036 12125000 10650000 4416335 4882822 19475401 18403858 X 21910324 24005232 21910324 24005232 41385725 42409090 1703150 391758 0 X X 0 1 X 1 0 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 695642 695642 22969566 5587898 17381668 7490030 4880678 2609352 7104 7104 20693766 BOND FUNDS 2111149 INVESTMENT IN YELLOWSTONE INSURANCE EXCHANGES RRG 165878 INVESTMENT IN MONIDA SHARED IMAGING 75000 2352027 26736500 391758 3034 394792 26341708 402266 402266 26743974 24641592 3034 3034 24638558 402266 402266 25040824 PART XI, LINE 2D - OTHER ADJUSTMENTS: DIRECT RENT EXPENSE DEDUCTED FROM GROSS RENTS FOR 990 REVENUE 3,034. PART XI, LINE 4B - OTHER ADJUSTMENTS: 340B PHARMACEUTICAL EXPENSES NETTED W/ REVENUE ON FINANCIAL STATEMENTS 175,849. BAD DEBT EXPENSE NETTED W/ REVENUE ON FINANCIAL STATEMENTS 226,417. PART XII, LINE 2D - OTHER ADJUSTMENTS: DIRECT RENT EXPENSE DEDUCTED FROM GROSS RENTS FOR 990 REVENUE 3,034. PART XII, LINE 4B - OTHER ADJUSTMENTS: 340B PHARMACEUTICAL EXPENSES NETTED W/ REVENUE ON FINANCIAL STATEMENTS 175,849. BAD DEBT EXPENSE NETTED W/ REVENUE ON FINANCIAL STATEMENTS 226,417. 1 1 1 X 250.000000000000 0 1 1 1 0 0 257213 257213 0.01030 6322488 6352218 0 0.00000 6579701 6352218 257213 0.01030 70163 2500 67663 0.00270 2500 2500 0.00010 56645 9030 47615 0.00190 14887 14887 0.00060 144195 11530 132665 0.00530 6723896 6363748 389878 0.01560 600 600 0.00000 1510 1510 0.00010 15773 15773 0.00060 17883 17883 0.00070 1 226417 0 8406712 8446504 -39792 X 1 1 1 CYPRESS HEALTHCARE LLC MANAGEMENT SERVICES 0.00000 1.00000 0.00000 1 1 POWELL COUNTY MEMORIAL HOSPITAL 1100 HOLLENBACK LANE DEER LODGE MT 59722 WWW.DLMED.ORG 12992 X X X X POWELL COUNTY MEMORIAL HOSPITAL 1 0 0 1 X X X X X X X X X 21 1 0 1 1 X WWW. DLMED.ORG X 1 21 1 WWW.DLMED.ORG 0 1 X 250.000000000000 X X 1 1 X X X 1 X WWW.DLMED.ORG X WWW.DLMED.ORG X WWW.DLMED.ORG X X X X X X 1 X 0 X X X X 1 X 0 0 POWELL COUNTY MEMORIAL HOSPITAL PART V, SECTION B, LINE 5: A STEERING COMMITTEE WAS CONVENED TO ASSIST DEER LODGE MEDICAL CENTER IN CONDUCTING CHSD. A DIVERSE GROUP OF COMMUNITY MEMBERS REPRESENTING VARIOUS ORGANIZATIONS AND POPULATIONS WITHIN THE COMMUNITY (EX. PUBLIC HEALTH, ELDERLY, UNINSURED) CAME TOGETHER IN OCTOBER 2021. FOR A LIST OF ALL STEERING COMMITTEE MEMBERS AND THEIR AFFILIATIONS, SEE APPENDIX A OF THE CHNA. THE STEERING COMMITTEE MET TWICE DURING THE CHSD PROCESS; FIRST TO DISCUSS HEALTH CONCERNS IN THE COMMUNITY AND OFFER THEIR PERSPECTIVE IN DESIGNING THE SURVEY INSTRUMENT, AND AGAIN TO REVIEW RESULTS OF THE CHNA AND TO ASSIST IN THE PRIORITIZATION OF HEALTH NEEDS. POWELL COUNTY MEMORIAL HOSPITAL PART V, SECTION B, LINE 6B: THE MONTANA STATE UNIVERSITY OFFICE OF RURAL HEALTH, AREA HEALTH EDUCATION CENTER, FACILITATED THE PREPARATION OF OUR COMMUNITY HEALTH NEEDS ASSESSMENT. POWELL COUNTY MEMORIAL HOSPITAL PART V, SECTION B, LINE 11: CHNA SIGNIFICANT NEED #1: ENHANCE DEER LODGE MEDICAL CENTER'S HEALTH AND WELLNESS OUTREACH IN POWELL COUNTY.STRATEGY #1: EXPAND AND ENHANCE HEALTH AND WELLNESS PROGRAMS AND RESOURCES AT DEER LODGE MEDICAL CENTER.ACTIVITIES: EXPLORE OPPORTUNITIES TO EXPAND PLANETREE MINDFULNESS AND WELLNESS PROGRAMS THROUGH DLMC TO THE COMMUNITY; SUSTAIN THE NUTRITIONAL OUTREACH CAMPAIGN (SUCH AS MONTHLY HEALTHY RECIPES TO BE FEATURED IN CAF AND SHARED ON THE DLMC FACEBOOK PAGE) THAT PROMOTE PREVENTION AND HEALTHY DIETS; CONTINUE TO PROVIDE HEALTH EDUCATION OPPORTUNITIES THAT PROMOTE HEALTH AND WELLNESS (I.E., PRE-DIABETES SUPPORT GROUP, TRIM THE TOWN, WOMEN'S NIGHT OUT, STOP THE BLEED, ANNUAL HEALTH FAIR, ETC.); SUSTAIN THE PROGRAM THAT FITS CHILD CAR SEATS FOR LOCAL FAMILIES. STRATEGY #2: CONTINUE TO SUPPORT AND SPONSOR ACTIVITIES AND PROGRAMS THAT PROMOTE PHYSICAL ACTIVITY IN POWELL COUNTY.ACTIVITIES: DLMC WILL CONTINUE TO PROVIDE STAFF TO PARTICIPATE ON THE LOCAL TRAIL COMMITTEE AND EXPLORE OPPORTUNITIES TO RAISE AWARENESS OF LOCAL TRAILS AND PROMOTE TRAIL UTILIZATION (I.E., BIKE WALK MONTANA, WALKING RX TRAILS); SPONSOR LOCAL ADULT AND YOUTH RECREATIONAL LEAGUES; CONTINUE TO HOST COMMUNITY EVENTS THAT PROMOTE PHYSICAL ACTIVITY (I.E., GOLF TOURNAMENT, ANNUAL HEALTH WALK, ETC.); CONTINUE TO PROVIDE YOUTH SPORTS PHYSICALS, CONCUSSION SCREENING AND HELMET PROMOTION PROGRAM.CHNA SIGNIFICANT NEED #2: ACCESS TO HEALTHCARE SERVICES IN POWELL COUNTY.STRATEGY #1: IMPROVE AND SUSTAIN ACCESS TO HEALTHCARE SERVICES IN POWELL COUNTY.ACTIVITIES: CONTINUE TO IMPLEMENT CARDIAC PULMONARY REHABILITATION PHASE TWO (I.E., MONITOR/TRACK PHYSICAL ACTIVITY AND NUTRITION AMONG IDENTIFIED ELIGIBLE PATIENTS THROUGH QUALIFYING EVENTS). CONTINUE TO REFER PROGRAM "GRADUATES" TO PHASE THREE (I.E., COMPLIMENTARY PASSES TO FITNESS CENTER TO REDUCE BARRIERS TO CONTINUING PHYSICAL ACTIVITY); DEVELOP AND IMPLEMENT A COMMUNITY INTEGRATED HEALTH PROFESSIONAL (CIH) PROGRAM DEPLOYING PARAMEDICS TO PROVIDE ADDITIONAL SERVICES TO HELP COMMUNITY MEMBERS ACCESS CARE IN NON-EMERGENCY SITUATIONS (I.E., POST DISCHARGE FOLLOW-UP, PREVENTIVE CARE, CHRONIC DISEASE MANAGEMENT, REFERRALS TO COMMUNITY HEALTH SERVICES, MEDICATION MANAGEMENT AND SET UP, HOME SAFETY CHECKS, ETC.); DLMC WILL CONTINUE TO WORK WITH AREA PARTNERS TO SUSTAIN AMBULANCE SERVICES IN POWELL COUNTY. DLMC WILL ALSO SUSTAIN THE PEDIATRIC PREPAREDNESS GOLD STANDARD AND CONTINUE PROVIDING REGULAR TRAINING AND SUPPLIES TO THE LOCAL QUICK RESPONSE UNITS; CONTINUE TO SUPPORT ANNUAL LOW-COST LABS AND MONTHLY FOOT CARE CLINICS; CONTINUE SPONSORING MONTHLY HEALTH OUTREACH OPPORTUNITIES THROUGH THE LOCAL SENIOR CENTER (I.E., BLOOD PRESSURE CHECKS, MEDICATION MANAGEMENT, ETC.); EXPLORE THE FEASIBILITY OF RECRUITING ADDITIONAL PRIMARY CARE PROVIDERS LOCALLY; SUSTAIN PATIENT NAVIGATOR SERVICES LINKING PATIENTS TO COMMUNITY RESOURCES. FACILITATE PRESUMPTIVE ELIGIBILITY STATUS FOR PROGRAMS LIKE MEDICAID, MEDICARE, 340B PROGRAM, ETC. IMPLEMENT METHODOLOGY AND PROTOCOLS TO SHARE FINANCIAL ASSISTANCE RESOURCES WITH THE COMMUNITY (I.E., CLINIC, EMERGENCY ROOM, DLMC WEBSITE, ETC.); CONTINUE TO IMPLEMENT TELEHEALTH CRISIS PROTOCOLS WHEN PATIENTS IN CRISIS PRESENT IN THE EMERGENCY ROOM; CONTINUE TO OFFER TELEPSYCHIATRY SERVICES LOCALLY, INCLUDING MEDICATION ASSISTANCE; CONTINUE TO OFFER TELE-ONCOLOGY SERVICES THROUGH DLMC. DLMC WILL HOST AN OPEN HOUSE IN JUNE 2022 TO RAISE THE COMMUNITY'S AWARENESS OF THIS SERVICE.STRATEGY #2: IMPROVE KNOWLEDGE OF SERVICES AVAILABLE THROUGH DEER LODGE MEDICAL CENTER AND IN THE COMMUNITY.ACTIVITIES: CONTINUE TO CONVENE A DLMC WORKGROUP/ADMINISTRATIVE TEAM TO DISCUSS CURRENT OUTREACH EFFORTS, GAPS AND NEW OPPORTUNITIES (I.E., ADA COMPLIANCE, WEBSITE DEVELOPMENT, ETC.). CONTINUE TO SUPPORT THE COMMUNITY RESOURCES PAGE ON DLMC WEBSITE THAT WAS BUILT DURING THE LAST IMPLEMENTATION PERIOD; CONTINUE TO SHARE OUTREACH FLYERS, HANDOUTS, AND MESSAGES ON THE SCREEN IN LOBBY DETAILING LOCAL RESOURCES (I.E., SENIOR SERVICES, MENTAL HEALTH RESOURCES, NEW SERVICES, FINANCIAL ASSISTANCE, ETC.); REVISIT OUTREACH/INFORMATION MATERIALS ABOUT DLMC PROVIDERS AND SERVICES (I.E., GRIEF SUPPORT GROUPS, TELEHEALTH SERVICES, ETC.) THAT WERE CREATED DURING THE LAST IMPLEMENTATION PERIOD; CONTINUE TO PROVIDE EDUCATION THROUGH PRESENTATIONS TO LOCAL ORGANIZATIONS (I.E., ROTARY CLUB, PUBLIC HEALTH, LOCAL SCHOOLS, ETC.).DLMC IS UNABLE TO ADDRESS THE FOLLOWING NEEDS AT THIS TIME:1. 59.2% OF SURVEY RESPONDENTS NOTED "ALCOHOL/SUBSTANCE ABUSE" AS A TOP HEALTH CONCERN FOR THE COMMUNITY. DEER LODGE MEDICAL CENTER (DLMC) PRIMARY CARE PROVIDERS COUNCIL PATIENTS ON SUBSTANCE ABUSE AS NEEDED BASED ON THE INDIVIDUAL AS PART OF THE GENERAL CARE. AS NECESSARY, PATIENTS ARE REFERRED TO SPECIALISTS FOR FURTHER HELP/TREATMENT.2. SURVEY RESPONDENTS INDICATED TO WHAT DEGREE THEIR LIFE HAS BEEN NEGATIVELY AFFECTED BY THEIR OWN OR SOMEONE ELSE'S SUBSTANCE ABUSE ISSUES, INCLUDING ALCOHOL, PRESCRIPTION, OR OTHER DRUGS: "A LITTLE (16.3%), "SOMEWHAT" (22.0%), AND "A GREAT DEAL" (16.3%). DEER LODGE MEDICAL CENTER (DLMC) PRIMARY CARE PROVIDERS COUNCIL PATIENTS ON SUBSTANCE ABUSE AS NEEDED BASED ON THE INDIVIDUAL AS PART OF THE GENERAL CARE. AS NECESSARY, PATIENTS ARE REFERRED TO SPECIALISTS FOR FURTHER HELP/TREATMENT.3. FOCUS GROUP PARTICIPANTS WERE INTERESTED IN AN IMPROVEMENT TO SENIOR SERVICES LOCALLY SPECIFICALLY ADDITIONAL SENIOR HOUSING OPTIONS AND HOME HEALTH SERVICES. COMMUNITY HOUSING IS BEYOND THE SCOPE OF THE SERVICES BEING FOCUSED ON BY DLMC. COMMUNITY GROUPS (I.E., COUNCIL ON AGING, RENAISSANCE, ETC.) ARE ACTIVE MEMBERS ON DLMC'S PATIENT FAMILY ADVISORY COUNCIL. DLMC SUPPORTS THESE SERVICES AND INITIATIVES AS POSSIBLE.4. 44.8% OF SURVEY RESPONDENTS INDICATED DESIRE IN "URGENT CARE" SERVICES AVAILABLE LOCALLY. ALL SERVICES PROVIDED THROUGH AN URGENT CARE MODEL ARE AVAILABLE THROUGH THE EXISTING DLMC CLINIC. THE RESOURCE AND STAFFING OF AN URGENT CARE WERE NOT IDENTIFIED AS A PRIORITY AT THIS TIME. BASED ON VOLUMES, WALK IN PATIENTS ARE TYPICALLY ABLE TO BE SEEN SAME DAY THROUGH THE DLMC CLINIC. PART I, LINE 7: PCMH USED COST-TO-CHARGE RATIOS FROM ITS MOST RECENT MEDICARE COST REPORT TO DETERMINE THE COST OF FINANCIAL ASSISTANCE, MEDICAID, PROVIDING REDUCED COST SPORTS PHYSICALS, AND PROVIDING REDUCED COST LABS. COST ACCOUNTING, WHICH INCLUDED ALL SEGMENTS (INPATIENT, OUTPATIENT, ER, ET AL) WAS USED TO DETERMINE ALL OTHER AMOUNTS REPORTED IN THE TABLE.BAD DEBT EXPENSE WAS NOT A FACTOR IN CALCULATING THE PERCENTAGES FOR COLUMN F. FORM 990, SCH H, PART I LINE C: WE ONLY OFFER A 100% WRITE OFF AT 250% OF FPG, OR IF OUT-OF-POCKET OBLIGATIONS RESULTING FROM MEDICAL SERVICES PROVIDED BY DLMC OVER THE LAST 12 MONTHS EXCEED 30% OF FAMILY INCOME. PART II, COMMUNITY BUILDING ACTIVITIES: ECONOMIC DEVELOPMENT: DONATED TO THE BIG SKY DRAFT HORSE EXPO AND TERRITORIAL DAYS.COMMUNITY SUPPORT: CFO SERVED ON THE POWELL COUNTY PUBLIC HEALTH BOARD AND OTHER PCMH/DLMC STAFF ATTENDED/PRESENTED AT THE MEETINGS. EMS DIRECTOR SERVICED AS A MEMBER OF THE POWELL COUNTY PLANNING BOARD. ADMIN TEAM MEMBER ATTENDED ROTARY CLUB MEETINGS. WORKFORCE DEVELOPMENT: PROVIDED INTERNSHIPS FOR LOCAL HIGH SCHOOL STUDENTS INTERESTED IN PURSUING A CAREER IN HEALTHCARE. MENTORED MSU STUDENTS PARTICIPATING IN A HEALTHCARE LEAN INTERNSHIP. PART III, LINE 2: TREND ANALYSIS OF SELF-PAY ACCOUNT COLLECTIONS IS USED TO CREATE AN INITIAL ESTIMATE THE PROVISION FOR BAD DEBT ON SELF-PAY ACCOUNTS RECEIVABLE AT FISCAL YEAR-END. THE ESTIMATE IS THEN REDUCED FOR IMPLICIT PRICE CONCESSIONS. THE INCREASE OR DECREASE IN THE PROVISION IS ADJUSTED TO BAD DEBT EXPENSE. SUBSEQUENT COLLECTIONS RECEIVED ON ACCOUNTS PREVIOUSLY WRITTEN OFF REDUCE THE CURRENT BAD DEBT EXPENSE. PART III, LINE 3: NONE OF THE ABOVE BAD DEBT IS INCLUDED AS COMMUNITY BENEFIT. PART III, LINE 4: SEE PAGE 14 OF THE ATTACHED AUDITED FINANCIAL STATEMENTS. PART III, LINE 8: BY CONTINUING TO TREAT PATIENTS ELIGIBLE FOR MEDICARE, THE HOSPITAL ALLEVIATES THE FEDERAL GOVERNMENT'S BURDEN FOR DIRECTLY PROVIDING MEDICAL SERVICES. COST ACCOUNTING (VIA THE MEDICARE COST REPORT) WAS USED TO DETERMINE THE ALLOWABLE MEDICARE COSTS. PART III, LINE 9B: PER OUR POLICY DLMC (PCMH) WILL NOT ENGAGE IN ECAS, EITHER DIRECTLY OR BY ANY DEBT COLLECTION AGENCY OR OTHER PARTY TO WHICH DLMC HAS REFERRED THE PATIENT'S DEBT, BEFORE REASONABLE EFFORTS ARE MADE TO DETERMINE WHETHER A RESPONSIBLE INDIVIDUAL(S) IS ELIGIBLE FOR ASSISTANCE UNDER THE FAP. PART VI, LINE 2: PCMH CONTINUES TO WORK THE LOCAL SCHOOLS, THE POWELL COUNTY PUBLIC HEALTH DEPARTMENT, POWELL COUNTY LOCAL EMERGENCY PREPAREDNESS COMMITTEE, MAJOR EMPLOYERS (SUN MOUNTAIN LUMBER, MONTANA STATE PRISON), LOCAL NURSING HOMES, POWELL COUNTY SENIOR CITIZEN CENTER, AND POWELL COUNTY COUNCIL ON AGING TO ASSESS THE HEALTH CARE NEEDS OF THE COMMUNITY WE SERVE. WE STRONGLY ENCOURAGE EMPLOYEES TO VOLUNTEER, ON PCMH TIME, FOR ORGANIZATIONS THAT STRIVE TO IMPROVE THE WELL-BEING OF OUR COMMUNITY MEMBERS. PART VI, LINE 3: PCMH STRIVES TO MEET WITH EVERY SELF-PAY PATIENT TO DETERMINE THEIR ABILITY TO PAY, AND OFFER FINANCIAL ASSISTANCE, MEDICAID PRESUMPTIVE ELIGIBILITY SCREENING, OR MONTHLY PAYMENT PLANS AS NEEDED. BEFORE TURNING AN ACCOUNT OVER TO 3RD PARTY COLLECTORS, WE PERFORM A REVIEW TO SEE IF THEY MEET THE PRESUMPTIVE ELIGIBILITY CRITERIA OF OUR FINANCIAL ASSISTANCE POLICY. SIGNS ARE POSTED THROUGHOUT THE FACILITY, ESPECIALLY AT PATIENT INTAKE AREAS, THAT NOTIFY PATIENTS OF THE AVAILABILITY OF FINANCIAL ASSISTANCE. NOTICES ARE ALSO INCLUDED WITH BILLING STATEMENTS. WITH OUR RECENT REMODELING PROJECT, WE MADE SURE TO INCORPORATE A SEPARATE OFFICE THAT IS EASILY ACCESSIBLE FOR PATIENTS TO DISCUSS THEIR ACCOUNTS IN PRIVATE WITH OUR PATIENT ACCESS MANAGER. PART VI, LINE 4: PCMH SERVES THE COUNTIES OF POWELL, GRANITE, DEER LODGE, AND SILVER BOW, AND ALSO PROVIDES SERVICES TO INMATES AT THE MONTANA STATE PRISON. PART VI, LINE 5: THE GOVERNING BOARD OF PCMH CONSISTS OF RESIDENTS OF THE HOSPITAL'S PRIMARY SERVICE AREA. EMPLOYEES NOR INDEPENDENT CONTRACTORS (OTHER THAN DISCLOSED ON THIS FORM) OF THE ORGANIZATION, NOR FAMILY MEMBERS THEREOF, ARE ALLOWED TO BE BOARD MEMBERS.PCMH EXTENDS MEDICAL STAFF PRIVILEGES TO QUALIFIED PROVIDERS IN THE COMMUNITY. WE'VE ALSO CONTRACTED WITH SEVERAL VISITING SPECIALISTS TO OFFER SERVICES NOT OTHERWISE AVAILABLE IN OUR COMMUNITY (CARDIOLOGY, PAIN MANAGEMENT, UROLOGY, PODIATRY, TELEPSYCHIATRY).PCMH CONTINUALLY REINVESTS SURPLUS FUNDS BY UPDATING OUR FACILITIES AND EQUIPMENT AND EMPLOYING ADDITIONAL STAFF TO EXPAND THE SERVICES OFFERED TO THE COMMUNITY OR IMPROVE CURRENTLY OFFERED SERVICES. THE HOSPITAL CONTINUES TO OPERATE POWELL EMERGENCY MEDICAL SERVICE, WHICH BOUGHT OUT THE FLAILING LOCAL VOLUNTEER AMBULANCE COMPANY IN 2020, TO ENSURE THAT THE COMMUNITY WOULD CONTINUE TO HAVE AMBULANCE SERVICES. ALTHOUGH PEMS RECEIVES A LARGE AMOUNT OF LEVY MONEY TO OPERATE THE SERVICE, IT REALIZED A NET LOSS FOR FISCAL YEAR 2024. SURPLUS FUNDS ARE ALSO USED TO OFFER PROGRAMS AT FREE OR REDUCED CHARGES TO THE COMMUNITY, SUCH AS THE FOLLOWING:- FREE FOOT CARE CLINIC FOR THE AGING, DISABLED, AND DIABETIC COMMUNITY - FREE BASELINE CONCUSSION TESTING FOR LOCAL STUDENT ATHLETES- LOW-COST SPORTS PHYSICALS TO LOCAL STUDENT ATHLETES- SCHOLARSHIPS TO HIGH SCHOOL STUDENTS PURSUING DEGREES IN HEALTH CARE- OFFERING LOW-COST LAB WORK TWO DAYS A YEAR AND DURING A PATIENT'S BIRTH MONTH.- OFFERING INTERNSHIP OPPORTUNITIES TO LOCAL HIGH SCHOOL STUDENTS INTERESTED IN CAREERS IN HEALTHCARE, AND MENTORING COLLEGE STUDENTS INTERNING IN HOSPITAL LEAN PROJECTS.- WE PROVIDE FREE TRAINING AND SUPPLIES TO LOCAL QUICK RESPONSE UNITS, VOLUNTEER FIRE DEPARTMENTS, AND VOLUNTEER AMBULANCE SERVICES.- MAINTAIN A COMMUNITY PLAYGROUND THAT PROVIDES A SAFE AREA FOR THE LOCAL YOUTH TO ENJOY HEALTHY OUTDOOR PLAY. X 1 1 X X X X X 0 0 0 0 0 0 0 0 0 SCOT MURRAY MD 485428 0 3500 0 0 0 16500 0 39739 0 545167 0 0 0 VAUGHN JOHNSON MD 390783 0 3500 0 0 0 0 0 37239 0 431522 0 0 0 LORI DRUMM DO 256574 0 3500 0 0 0 13550 0 30219 0 303843 0 0 0 SUMERA QAMAR MD 276129 0 3500 0 0 0 0 0 13851 0 293480 0 0 0 JUDITH WILSON MD 239627 0 3500 0 0 0 0 0 14166 0 257293 0 0 0 JAENA RICHARDS COO 208242 0 3500 0 0 0 10850 0 27543 0 250135 0 0 0 PATRICK KRACH COO 228247 0 3500 0 0 0 0 0 14361 0 246108 0 0 0 ANDREW BECK CNO 170295 0 3500 0 0 0 9123 0 24325 0 207243 0 0 0 JENNIFER SPRING CFO 163271 0 3500 0 0 0 8189 0 343 0 175303 0 0 0 PART I, LINE 1A THE ORGANIZATION PAYS CEO, TONY PFAFF'S DUES TO ROCK CREEK CATTLE COMPANY AS THE ORGANIZATION USES THE FACILITY FOR DINING AND LODGING WHEN RECRUITING PHYSICIANS AND OTHER KEY EMPLOYEES. THIS IS NOT INCLUDED IN TONY'S TAXABLE INCOME. A MONTANA FACILITY FINANCE AUTHORITY 364615115 612043GQ6 2010-08-01 15000000 TO FINANCE THE CONSTRUCTION AND EQUIPPING OF A NEW HEALTH CARE FACILITY 0 0 0 A 3605000 15000000 1184142 13557042 258697 2011 0 0 1 1 A 0 0 0 0 0 0 1 A 0 0 0 0 0 0 0 0 0 A 0 CYPRESS HEALTHCARE LLC THE HOSPITAL'S CURRENT CEO, TONY PFAFF, OWES CYPRESS HEALTHCARE, LLC 652074 MR. PFAFF IS THE OWNER OF CYPRESS HEALTHCARE, LLC, THE INDEPENDENT CONTRACTOR HIRED TO MANAGE THE HOSPITAL. HE RECEIVES ALL COMPENSATION FOR HIS SERVICES AS CEO FROM CYPRESS HEALTHCARE, LLC. 0 JACK ANDERSON MR. ANDERSEN IS A MEMBER OF PCMC'S BOARD OF DIRECTORS. 39500 MR. ANDERSEN SERVES AS THE HOSPITAL'S PHARMACIST. 0 CARLEE HANSEN MS. HANSEN IS A MEMBER OF PCMH'S BOARD OF DIRECTORS 16200 THE HOSPITAL RENTS AN APARTMENT FROM MS. HANSEN. 0 FORM 990, PART VI, SECTION A, LINE 3 THE HOSPITAL HAS A MANAGEMENT AGREEMENT WITH CYPRESS HEALTHCARE, LLC WHICH COVERS ADMINISTRATOR COMPENSATION, MANAGEMENT FEES, AND MISCELLANEOUS EXPENSES SUCH AS TRAVEL. TONY PFAFF, CEO OF THE HOSPITAL, IS THE OWNER OF CYPRESS HEALTHCARE, LLC. OF THE FEES PAID TO CYPRESS HEALTHCARE, $474,719 WERE FOR CEO SERVICES. FORM 990, PART VI, SECTION B, LINE 11B THE CEO AND CFO REVIEW THE 990 PRIOR TO ITS FILING. THE BOARD IS THEN INFORMED THE 990 IS AVAILABLE TO BE REVIEWED AT THEIR REQUEST. FORM 990, PART VI, SECTION B, LINE 12C IN CONNECTION WITH ANY ACTUAL OR POSSIBLE CONFLICT OF INTEREST, AN INTERESTED PERSON MUST DISCLOSE THE EXISTENCE OF THE FINANCIAL INTEREST AND BE GIVEN THE OPPORTUNITY TO DISCLOSE ALL MATERIAL FACTS TO THE DIRECTORS AND MEMBERS OF COMMITTEES WITH GOVERNING BOARD DELEGATED POWERS CONSIDERING THE PROPOSED TRANSACTION OR ARRANGEMENT. AFTER DISCLOSURE OF THE FINANCIAL INTEREST AND ALL MATERIAL FACTS, AND AFTER ANY DISCUSSION WITH THE INTERESTED PERSON, HE/SHE SHALL LEAVE THE GOVERNING BOARD OR COMMITTEE MEETING WHILE THE DETERMINATION OF A CONFLICT OF INTEREST IS DISCUSSED AND VOTED UPON. THE REMAINING BOARD OR COMMITTEE MEMBERS SHALL DECIDE IF A CONFLICT OF INTEREST EXISTS. AN INTERESTED PERSON MAY MAKE A PRESENTATION AT THE GOVERNING BOARD OR COMMITTEE MEETING, BUT AFTER THE PRESENTATION, HE/SHE SHALL LEAVE THE MEETING DURING THE DISCUSSION OF, AND THE VOTE ON, THE TRANSACTION OR ARRANGEMENT INVOLVING THE POSSIBLE CONFLICT OF INTEREST. AFTER EXERCISING DUE DILIGENCE, THE GOVERNING BOARD OR COMMITTEE SHALL DETERMINE WHETHER THE ORGANIZATION CAN OBTAIN, WITH REASONABLE EFFORTS, A MORE ADVANTAGEOUS TRANSACTION OR ARRANGEMENT FROM A PERSON OR ENTITY THAT WOULD NOT GIVE RISE TO A CONFLICT OF INTEREST. FORM 990, PART VI, SECTION B, LINE 15 COMPENSATION DETERMINATION IS A JOINT EFFORT BY THE MANAGEMENT COMPANY AND THE BOARD OF DIRECTORS. FORM 990, PART VI, SECTION C, LINE 19 THE HOSPITAL MAKES ITS GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY & FINANCIAL STATEMENTS AVAILABLE TO THE PUBLIC UPON REQUEST. FORM 990, PART IX, LINE 11G PURCHASED SERVICES: PROGRAM SERVICE EXPENSES 2,616,142. MANAGEMENT AND GENERAL EXPENSES 90,327. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 2,706,469. PROFESSIONAL FEES: PROGRAM SERVICE EXPENSES 643,321. MANAGEMENT AND GENERAL EXPENSES 677,494. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 1,320,815. FORM 990, PART XII, LINE 2C: THE ORGANIZATION HAS A COMMITTEE WHICH ASSUMES OVERSIGHT OF THE AUDIT/REVIEW OF ITS FINANCIAL STATEMENTS AND SELECTION OF AN INDEPENDENT ACCOUNTANT. THERE HAVE BEEN NO CHANGES TO THE POLICY IN THE CURRENT YEAR. POWELL EMERGENCY MEDICAL SERVICES LLC 1100 HOLLENBACK LANE DEER LODGE MT 59722 843599616 AMBULANCE SERVICE MT 1069473 329765 POWELL COUNTY MEMORIAL HOSPITAL ASSOC POWELL COUNTY MEDICAL FOUNDATION 1100 HOLLENBACK LANE DEER LODGE MT 59722 810438377 RAISE FUNDS FOR POWELL COUNTY MEMORIAL HOSPITAL. MT 501(C)(3) LINE 12C, III-FI 0 0 0 1 0 0 0 0 0 0 0 0 0 0 1 1 0 0 0 0 POWELL COUNTY MEDICAL FOUNDATION C 1899